Name of the Procedure:

Modification of Off-the-Shelf Depth-Inlay Shoe or Custom-Molded Shoe with Off-Set Heel(s) for Diabetics (HCPCS Code: A5506)

Summary

This procedure involves modifying a pre-made or custom-made shoe to provide better support and fit for diabetics. The shoe's heel may be adjusted to off-set or correct specific foot conditions, which is crucial for preventing complications and improving comfort.

Purpose

The main goal of this procedure is to prevent and manage diabetic foot complications by ensuring proper foot alignment and support. This can reduce the risk of ulcers, sores, and other foot problems common in diabetic patients.

Indications

• Patients with diabetes experiencing foot deformities or abnormalities.
• Individuals with a history of foot ulcers or sores.
• Diabetics with improper gait or foot alignment causing pain or mobility issues.

Preparation

• A thorough foot examination by a healthcare professional.
• Potential measurements and moldings of the patient's feet.
• Discussion of any current issues, such as pain or sores, that need special attention.
• No specific fasting or medication adjustments required unless advised by a healthcare professional.

Procedure Description

1. Foot Evaluation: Initial assessment of the patient's foot structure and any existing conditions.
2. Shoe Selection: Choice of an appropriate off-the-shelf or custom-molded shoe.
3. Modification Planning: Determination of specific heel modifications needed.
4. Implementation:
   • Using specialized tools to adjust shoe structure.
   • Adding or reshaping inlays to distribute foot pressure evenly.
   • Testing and refining the fit.
5. Fitting: Ensuring the modified shoe properly fits the patient and addresses the identified foot issues.

Duration

Typically completed within 1-2 hours, though this may vary based on the complexity of the modifications.

Setting

The procedure is usually performed in a specialized outpatient clinic or a podiatry office.

Personnel

• Podiatrists or orthopedic specialists
• Certified orthotists or prosthetists
• Trained medical assistants or technicians

Risks and Complications

• Possible discomfort or pain if the shoe modification is incorrect.
• Risk of pressure points leading to new sores or ulcers.
• Rarely, allergic reactions to materials used in the modification.

Benefits

• Improved foot comfort and support.
• Reduced risk of diabetic foot ulcers and complications.
• Enhanced mobility and quality of life.
• Benefits can be realized immediately with proper fitting and adjustment.

Recovery

• Patients can usually resume normal activities immediately, with new shoes being worn as advised.
• Follow-up appointments may be needed to ensure the shoe remains effective and to make any further adjustments.
• Patients should inspect their feet regularly for any signs of irritation or sores and report these to their healthcare provider.

Alternatives

• Using custom orthotic inserts without shoe modifications.
• Purchasing specialized diabetic footwear designed to offer extra support without additional modification.
• Pros: Easier and often quicker to implement.
• Cons: May not provide the personalized support needed for specific foot conditions.

Patient Experience

During the procedure, patients may experience mild discomfort but generally should feel no pain. Afterward, they might need some time to adjust to the feel of the modified shoe. Pain management, if necessary, can typically be handled with over-the-counter medications. Regular check-ups will help ensure ongoing comfort and effectiveness.